Peds, part 28: Cardiovascular Disorders - Iron Deficient Anemia, Sickle Cell Anemia

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In this video and article, we cover two pediatric disorders: iron-deficiency anemia, and sickle cell anemia, including definitions, pathophysiology, risk factors, signs and symptoms, labs and diagnostics, treatment, nursing care, and family teaching

The Pediatric Nursing video series follows along with our Pediatric Nursing - Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

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Pediatric iron-deficiency anemia

Iron-deficiency anemia is a decrease in hemoglobin due to inadequate intake of iron-rich foods, or a malabsorption disorder that prevents the absorption of iron.

Pediatric iron-deficiency anemia risk factors

A key risk factor for pediatric iron-deficiency anemia is excess intake of cow's milk. Milk is low in iron, and if a child is drinking excess cow's milk, then it will fill them up, and they are less likely to be hungry enough to eat foods at mealtimes which may be higher in iron.

Pediatric iron-deficiency anemia signs and symptoms

Signs and symptoms of iron-deficiency anemia include fatigue, pallor, shortness of breath, and tachycardia.

Pediatric iron-deficiency anemia labs and diagnostics

When diagnosing pediatric iron-deficiency anemia, the lab values you would expect to see would include decreased hemoglobin, hematocrit, red blood cells, mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), and ferritin (a protein that stores and releases iron).

Check out our Blood Panel article to learn more about the expected ranges for these lab values. If you’d like to learn more about this and other lab values, check out our lab value flashcards for nursing students.

Pediatric iron-deficiency anemia treatment

Pediatric iron-deficiency anemia is usually treated with iron supplementation, including ferrous sulfate, which is the oral form of iron supplementation, or iron dextran, which would be administered through the intramuscular or intravenous route.

Pediatric iron-deficiency anemia nursing care

The nursing care points you need to know for pediatric iron-deficiency anemia are the best practices to follow when administering iron supplementation intramuscularly:

  • Use the Z-track method in order to prevent leakage of the medication into the subcutaneous tissue.
  • Do not massage.

Pediatric iron-deficiency anemia family teaching

Family teaching for pediatric iron-deficiency anemia includes nutrition, liquids that are indicated/contraindicated for supplement administration, dental care, and stool changes.

Nutrition for pediatric iron-deficiency anemia

Encourage the caregivers of patients with pediatric iron-deficiency anemia to increase the patient's intake of iron-rich foods, which include green vegetables, meat, raisins, and iron-fortified foods.

Best liquids to have with iron supplements

Inform caregivers that vitamin C improves the absorption of iron, and calcium-rich products will decrease absorption of iron. So the caregivers should give the iron supplementation with orange juice instead of milk or antacids!

Dental care on iron supplements

If the child is prescribed iron supplementation in a liquid form, let the family know that the child should use a straw and brush their teeth following administration in order to avoid stained teeth.

Stool changes on iron supplements

It's important to note that iron supplementation will cause green or black tarry stools. This is an expected finding with an iron supplement, and it is not anything to worry about.

Pediatric sickle cell anemia

This article is about pediatric sickle cell anemia. For info on sickle cell anemia in adults, check out Med-Surg - Cardiovascular System, part 24: Anemia, Sickle Cell Anemia.

Sickle cell anemia is an autosomal recessive genetic disorder that causes chronic anemia, pain, infection, and organ damage.

In sickle cell anemia, the body's normal hemoglobin (HbA) is replaced with abnormal sickle hemoglobin (HbS) and this causes sickling of the red blood cells.

What is sickling?

A sickle is a handheld farming/harvesting tool made up of a C-shaped blade attached to a handle. You've probably seen the "hammer and sickle" symbol before—a communist symbol representing solidarity of the working class. The sickle tool is extremely old (like 10,000 years old!) so, from this tool came the name of a shape—something that is sickle-shaped is C shaped or curved like a C.

Enough history—back to sickle cell anemia. Normally, red blood cells are round, and this round shape allows them to move, bounce, and flow easily throughout the blood vessels. When a red blood cell "sickles" it turns into a sickle or C shape, which unfortunately allows it to easily get caught in the blood vessels, which obstructs blood flow to the organs and can result in tissue hypoxia.

Pediatric sickle cell anemia risk factors

Risk factors for pediatric sickle cell anemia include a family history of the condition, and in the United States, sickle cell anemia most commonly affects people of African, Mediterranean and Middle Eastern descent.

Pediatric sickle cell anemia signs and symptoms

Overall signs and symptoms of pediatric sickle cell anemia include pain, fatigue, shortness of breath, pallor, and jaundice.

When a patient has sickle cell anemia, they will often experience crises, and there are several crises to be familiar with: vaso-occlusive, splenic sequestration, and aplastic crisis. There are also two more crises: acute chest syndrome, and hyperhemolytic crisis, but it's less likely (though not impossible!) that you would be tested for those on a nursing exam.

Vaso-occlusive crisis

During a vaso-occlusive crisis, a patient will have severe pain that will need to be treated with opioid analgesics around the clock. They may also have swelling in their hands and feet.

Splenic sequestration crisis

A splenic sequestration crisis is where blood flow is blocked out of the spleen due to the sickling of the red blood cells, and this causes enlargement of the spleen. The patient may also exhibit hypovolemic shock.

Aplastic crisis

An aplastic crisis is severe anemia that is typically related to a viral infection.

Acute chest syndrome

Acute chest syndrome is a type of crisis where blood flow to the lungs is impaired, causing the patient to have dyspnea, fever, and cough.

Hyperhemolytic crisis

A hyperhemolytic crisis is characterized by a rapid decrease in hemoglobin levels.

Pediatric sickle cell anemia labs and diagnostics

Diagnosing pediatric sickle cell anemia includes a sickle turbidity test, which will detect the abnormal hemoglobin (HbS) or a hemoglobin electrophoresis. During hemoglobin electrophoresis, electrical charges are used to separate the hemoglobin by type so the amount of HbA vs. HbS can be determined.

Pediatric sickle cell anemia treatment

Treatment for pediatric sickle cell anemia includes opioid analgesics (on a schedule), antibiotics for infection, and hydroxyurea (off-label for children).

Pediatric sickle cell anemia nursing care

Pediatric sickle cell anemia nursing care includes administering IV fluids, blood products, and oxygen as ordered.

The administration of IV fluids helps decrease the viscosity of the blood, which helps the flow of blood to the organs, which will help prevent tissue hypoxia.

Pediatric sickle cell anemia family teaching

Encourage the patient's family to help ensure the patient gets adequate fluid intake and rest, to prevent the onset of a vaso-occlusive crisis. To avoid infection, practice meticulous hand hygiene and avoid crowds. Take penicillin prophylaxis as ordered. Seek immediate medical attention for fever or illness.

Quiz Questions

A toddler who drinks an excess amount of cow's milk is at risk for what disorder?

Iron-deficiency anemia

What increases and what decreases iron absorption?

Vitamin C increases iron absorption, and dairy products decrease iron absorption

How should pain be treated for a patient with sickle cell anemia experiencing a vaso-occlusive crisis?

Their pain should be treated with opioid analgesics around the clock

Full Transcript: Peds, part 28: Cardiovascular Disorders - Iron Deficient Anemia, Sickle Cell Anemia

Hi, I'm Cathy with Level Up RN. In this video, I will be talking about iron-deficient anemia as well as sickle cell anemia. If you have our Level Up RN Pediatric Nursing Flashcards, definitely pull those out and pay close attention to the bold red text on these cards because those are going to be particularly important facts for you to know. And at the end of this video, I'm going to give you guys a little quiz to test your understanding of some of the key points I'll be covering in this video, so definitely stay tuned for that.

First up, we have iron-deficient anemia, which is a decrease in hemoglobin due to insufficient iron intake or some kind of malabsorption syndrome that prevents the absorption of iron. So a key risk factor in young children is the excess intake of cow's milk. So if a kid is sucking down the cow's milk all day long, which is low in iron, then it's really filling them up, and they are less likely to eat foods which may be higher in iron. So signs and symptoms of iron-deficient anemia include fatigue, pallor, shortness of breath, as well as tachycardia. In terms of labs, we will see a decrease in the hemoglobin, hematocrit, red blood cells, MCH, MCV, and ferritin. Treatment of this condition would be done with iron supplementation, so this would be ferrous sulfate, which is the oral form of iron supplementation, or iron dextran, which would be administered through the IM or IV route. If we are administering iron supplementation via the IM route, we want to make sure we use the Z-track method in order to prevent leakage of the medication into the subcutaneous tissue.

In terms of family teaching, we want to encourage increased intake of iron-rich foods, which include green vegetables, meat, raisins, and iron-fortified foods. We also want to let the family know that vitamin C improves absorption of iron, and calcium-rich products will decrease absorption of iron. So we want our family to give the iron supplementation with orange juice and not with milk or antacids. We also want to let the family know that the child should use a straw and brush their teeth following administration in order to avoid stained teeth. This is if they're taking their iron supplementation in a liquid form. In addition, iron supplementation will cause green or black tarry stools, and this is an expected finding when we are giving an iron supplement, and it is not anything to worry about.

When a patient has sickle cell anemia, they will often experience crisises, and there are several crisises to be familiar with. Probably the most important one to know is called a vaso-occlusive crisis. So during this type of crisis, the patient will have severe pain that will need to be treated with opioid analgesics around the clock. They may also have swelling in their hands and feet during this type of crisis. Another type of crisis is a splenic sequestration crisis. So with this type of crisis, blood flow is blocked out of the spleen due to that sickling of the red blood cells, and this causes enlargement of the spleen. The patient may also exhibit hypovolemic shock. Then we have an aplastic crisis. So this is where we have severe anemia that is typically related to a viral infection. Then we have something called an acute chest syndrome, which is a type of crisis where blood flow to the lungs is impaired, so the patient will have dyspnea, fever, and cough. And then we have a hyperhemolytic crisis, which is characterized by a rapid decrease in hemoglobin levels.

In terms of diagnosis of sickle cell anemia, we can do what's called a sickle turbidity test, which will detect that abnormal hemoglobin, that HbS. We can also do something called a hemoglobin electrophoresis. In terms of treatment, we're going to give those opioid analgesics on a schedule. In addition, we need to provide antibiotics if there's an infection present. In addition, we will need to administer IV fluids to help decrease the viscosity of the blood because we're trying to help the flow of blood get to the organs, which will help prevent tissue hypoxia. And then we would give blood products and oxygen as ordered.

In terms of patient teaching, we're definitely going to want to encourage our patient to get enough fluid intake to help prevent dehydration and prevent the onset of a vaso-occlusive crisis. We also want them to avoid getting infection, so they need to perform meticulous hand hygiene and avoid crowds as well.

Now let's talk about sickle cell anemia, which is an autosomal recessive genetic disorder that causes chronic anemia, pain, infection, as well as organ damage. So the pathophysiology behind this disorder is that our normal hemoglobin, which is HbA, is replaced with abnormal sickle hemoglobin, which is HbS, and this causes sickling of the red blood cells. So normally, red blood cells are nice and round. When we have the sickling, they kind of turn into this C shape, and these red blood cells get easily caught in the blood vessels, which obstructs blood flow to the organs and can result in tissue hypoxia.

So in terms of risk factors associated with this condition, a family history is obviously going to be a risk factor because this is a genetic disorder. Also, African Americans and those of Middle Eastern descent are at higher risk for sickle cell anemia. Overall signs and symptoms include pain, fatigue, shortness of breath, pallor, as well as jaundice.

All right, it's time for a quiz. I've got three questions for you. First question, a toddler who drinks an excess amount of cow's milk is at risk for what disorder? The answer is iron-deficient anemia. Question number two, what increases and what decreases iron absorption? The answer is vitamin C increases iron absorption, and dairy products decrease iron absorption. Question number three, how should pain be treated for a patient with sickle cell anemia experiencing a vaso-occlusive crisis? The answer is their pain should be treated with opioid analgesics around the clock. All right, that's it for this video. Hope it was helpful. Take care and good luck with studying.

[BLOOPERS]

First up, we have iron-deficient anemia. This is where we have decreased hemoglobin due to insufficient iron intake or some kind of malabsorption disorder that prevents a-- [laughter] next.

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